Arizona Health Care Cost Containment System
Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Teamwork
First Resume Review: 01/25/2019
This position will remain open until filled
Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid Agency, is driven by the passion to deliver comprehensive and cost effective health care to Arizonans in need. AHCCCS is nationally acclaimed as a model for other Medicaid programs and recipient of multiple awards for excellence in workplace effectiveness and flexibility.
All Arizona state employees operate within the Arizona Management System (AMS), an intentional, results-driven approach for doing the work of state government whereby every employee reflects on performance, reduces waste, and commits to continuous improvement with sustainable progress. Through AMS, every state employee seeks to understand customer needs, identify problems, improve processes, and measure results. State employees are highly engaged, collaborative and embrace a culture of public service. Visit our careers page to learn more about AHCCCS. Use your skills to benefit others; join the AHCCCS Team!
The Office of Administrative Legal Services (OALS) is looking for a highly motivated individual to join our team as a Senior Investigator. This position will provide oversight of the grievances and appeals processes of the entities contracted by AHCCCS to provide publicly funded physical and behavioral health services in Arizona. Major duties and responsibilities include but are not limited to:
* Performing complex investigations of SMI abuse/death. Conducting statewide in-person and/or telephonic interviews of witnesses, staff, SMI consumers, and alleged perpetrators; reviewing and processing data, documents, and medical records; drafting investigation reports, decision letters, appendixes, and maintaining case files; testifying as a witness at administrative fair hearings.
* Processing and drafting decision letters for administrative appeals from contractor decisions relating to alleged SMI rights violations.
* Mediating informal conferences for appeals of contractor decisions relating to behavioral health services for persons with SMI.
* Performing quarterly audits encompassing the following grievance and appeal processes: Title XIX/XXI appeals, provider claim disputes, Serious Mental Illness (SMI) appeals, and SMI grievances.
* Providing technical assistance to contractors and other stakeholders regarding Title XIX/XXI appeals, claim disputes, SMI grievances and SMI appeals; reviewing and providing feedback regarding deliverables from contractors.
* Other duties as assigned as related to the position
KNOWLEDGE, SKILLS AND ABILITIES (KSAs):
* Must have knowledge of federal and state laws and civil and administrative laws; AHCCCS policies and procedures related to the grievance and appeal process for Title XIX/XXI enrollees and/or persons with SMI
* Demonstrated knowledge of claim processing procedures, financing contracts and operation of RBHAs; regulations and policies and procedures that apply to RBHAs and various providers who contract with them; RBHA risk management incident/accident/death AHCCCS reporting requirements.
* Demonstrated knowledge of investigative methods, techniques, and approaches necessary to plan and conduct investigations of a highly sensitive nature relating to physical abuse, sexual abuse, sexual misconduct, and deaths of SMI consumers; medical terminology and procedure to review specific medical records; legal compliance issues of confidentiality, release of records, release of information and subpoenas
* Demonstrated knowledge of performance management (PM) model and continuous quality improvement (CQI) methods in a public health setting; SMI consumer evaluation, assessment, individual service planning, and at-risk crisis planning
* Strong ability to effectively and efficiently address grievance and appeal issues by utilizing a combination of exemplary writing skills, excellent verbal communication skills and excellent analytical skills.
* Strong ability to interact effectively with RBHAs and subcontracted providers and their staff, and if necessary, law enforcement officials regarding investigatory matters; Skilled in investigative techniques, including interviewing techniques, recall, recordation and preservation of data.
* Skilled in the use of databases, Microsoft Excel, Word, PowerPoint and/or other comparable software programs.
* CLEAR investigator certification or equivalent Investigator training or the ability to obtain CLEAR Investigator certification.
* Requires possession of and ability to retain a current, valid state-issued driver's license appropriate to the assignment. Employees who drive on state business are subject to driver's license record checks, must maintain acceptable driving records, and must complete any required driver training (See Arizona Administrative Code R2-10-207.12).
* An academic background indicative of exemplary writing skills, excellent verbal communication skills, and excellent analytical skills.
At AHCCCS, we promote the importance of work/life balance by offering workplace flexibility and a variety of learning and career development opportunities. Among the many benefits of a career with the State of Arizona, there are 10 paid holidays per year, accrual of sick and annual leave, affordable medical benefits and participation in the Arizona State Retirement Plan. Click here to learn more about benefits.
Arizona State Government is an EOE/ADA Reasonable Accommodation Employer. Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by calling (602) 417-4497. Requests should be made as early as possible to allow sufficient time to arrange the accommodation. AHCCCS is an Equal Employment Opportunity Employer. All newly hired employees will be subject to E-Verify Employment Eligibility Verification.
Click the APPLY NOW button to submit your application.
For technical assistance, email HRIShelpdesk@azdoa.gov or call 602-542-4700.